13
Respiratory Tract
Table 13.23 Role of the Number of Cytopathologic Specimens in Diagnosis (424 Patients with Three or More Satisfactory Specimens)
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Table 13.24 Role of the Number of Cytopathologic Specimens in Diagnosis (381 Patients with Five or More Satisfactory Specimens)
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the first specimen of bronchial material in 22.4%. From these
studies, the following conclusions were made.
First and most important, diagnostic respiratory cytology had
played a significant part in lung cancer diagnosis. Of a total of 715
consecutive patients with accepted primary lung cancer, an une-
quivocal cytologic diagnosis of cancer was made in 357 patients,
or approximately 50% of the cases. Second, examination of mul-
tiple specimens of material from the lower respiratory tract was
mandatory if the method were to be used maximally. From long
experience, it is now known that some lung cancers, for reasons
yet unknown, do not exfoliate diagnostic cells regardless of the
number of specimens collected; however, in those patients who
yield diagnostic cytologic specimens, five specimens make a
definitive diagnosis in more than 85% of cases. Third, it is
worth continued emphasis that no one specimen type was of
exclusive importance in lung cancer diagnosis. Both sputum
and bronchial material were essential for maximum diagnos-
tic accuracy. It is of interest, however, that in these studies,
sputum was equal if not superior to bronchial material in the
percentage of cancers diagnosed. In comparison, 26.0% of
the cancers would have been missed had bronchial material
not been examined. In our experience, clinicians frequently
lose sight of the extreme diagnostic importance of the early
morning deep-cough specimen of sputum. Instead, they tend
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